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WHO recently released a medical school curriculum in patient safety. To date the number of downloads is in the 1000s. The curriculum includes teaching resources on systems thinking in healthcare, medical errors and other key areas of patient safety.

I was at WHO HQ in Geneva when the curriculum was proposed in May 2006. This week I took part in an online forum devoted to the WHO curriculum, which so far has 1400 professionals from 110 countries registered, all eager to make patients safer and improve teaching at an undergraduate level. Change in action!

Addressing patient safety early has many advantages. It’s still relatively difficult to challenge the prevailing culture in medicine, although this is changing. Take error reporting, or measures for quality, for example. It all sounds like a great idea when we first hear about it, but trying to get even a few people on board in any one clinical unit can be difficult. Getting it back to day 1 of medical school and other health care workers’ training programmes presents the possibility of change from the bottom up. Of course, students may still be disappointed how different the ‘real world’ turns out to be, but in theory at least, over time, change should occur. There are other benefits too, such as healthcare workers themselves promoting safe practice in both public and private settings, as opposed to just mandates from the top down.

Patient safety has been embraced by many governments and high level medical bodies, but many providers and individuals are less engaged. That’s another good reason why we need to get back to undergraduate level with patient safety; ensuring safety is ingrained in the culture, so that healthcare workers lead the agenda.

Most of the things that WHO Patient Safety were doing in 2006 were geared to the current problems in patient safety and not about institutionalizing patient safety, as one member of the online forum described it this week. To achieve this we had to get back to undergraduate level and change the future as well as the present. When we suggested starting with medical students and going from there, I remember very clearly a senior nurse saying: ‘what about the nurses!’ In an ideal world I think we would have had a multidisciplinary curriculum from day 1. This would have enabled us to get at some of the problems with communication and teamwork across the board. Yet, working within the structures that most countries have to medical education we decided to start with medial students and build slowly and carefully to cover the whole spectrum of healthcare workers. I think we’ve all been surprised how much progress has been made so far!

Douglas Noblehas worked in surgery, emergency medicine, public health and for WHO Patient Safety. From 2006 to 2008 he was clinical adviser to chief medical officer for England, Sir Liam Donaldson.

Highlighting the importance of patient safety and quality to undergraduates is a great idea. However, there are significant challenges involved in fully integrating safety and quality into the undergraduate curriculum. In England, this involves getting buy-in from individual deans of medical schools, the medical schools council and medical education england (to name a few stakeholders). The diversity of undergraduate programmes leads to wide variation in the quality of Foundation year 1 doctors who have a wide range of skills, knowledge and competencies. I think patient safety and quality are ideal themes to align diverse undergraduate curricula through the organising principle of producing Foundation Year 1 doctors who are competent, safe and deliver high quality care for patients.